Basic Information
| Provider Information | |||||||||
| NPI: | 1750506580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | VALARIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 E COOLEY DR | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923246324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093701777 | ||||||||
| FaxNumber: | 9093701776 | ||||||||
| Practice Location | |||||||||
| Address1: | 1963 N E ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924053919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098816146 | ||||||||
| FaxNumber: | 9098813479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | F0502030909 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.